Speeding Access to Specialty Meds in Oncology: How Electronic Prior Authorizations Make It Possible

Cancer death rates are declining, thanks to advances in early detection and innovative therapies that offer patients hope—if they can get past access and affordability barriers. However, as payers seek to manage use of specialty medications with rigorous prior authorization (PA) requirements, patient access has become even more complicated, especially for oncology medications.  

PAs for specialty medications can fall under pharmacy or medical benefits—sometimes both—which makes them particularly challenging. Not surprisingly, Oncology Insights found that 70% of oncologists now require full-time staff just to manage PAs.  

Is your EHR up to the challenge? Integrating electronic PAs (ePAs) in existing workflows can be a game-changer.

How PAs Impact Cancer Care 

Cancer patients already face immense challenges; the added burden of PAs complicates access to essential treatments. Breast oncologist Debra Patt, M.D., PhD, explained how these requirements affect patient care in an AMA podcast. 

“Prior authorization has become a real challenge for patients to get the care they need,” Dr. Patt shared. She added that she regularly encounters PAs when ordering imaging studies to evaluate the extent of a patient’s cancer involvement and when prescribing new therapies. 

A survey of oncologists by the Association for Clinical Oncology (ASCO) mirrors Dr. Patt’s experiences with PA-related barriers:  

• Treatment delays: 96% reported delays in getting patients on prescribed therapies. 

• Denials for critical services: Cancer therapy (87%), genetic testing (76%), supportive care (72%), and screening (61%) faced frequent denials. 

• Second-choice therapies: 93% reported step therapy requirements that pushed patients to less optimal treatments. 

• Higher hospitalization rates: 74% noted more ER visits or hospital stays for patients. 

• Care abandonment: 64% saw patients abandoning treatment. 

• Cancer progression or death: 80% reported disease progression and 36% reported deaths linked to treatment delays.

Treatment Delays Contribute to Poorer Outcomes 

For patients with serious, life-threatening disease, PAs are much more than hoops to jump through; they can be barriers preventing optimal care. For example, analysis of mortality due to cancer treatment delay, published by BMJ, reveals that even a four-week delay increases mortality related to seven cancers treated using chemotherapy infusions, surgeries, or radiotherapy. 

“Sometimes we lose patients because cancer is terrible and maybe we don’t have other things to offer—but when we do have the best treatments to offer and cannot get it to the patients we serve who pay for their insurance, it’s really frustrating and demoralizing as a physician,” Dr. Patt said. “And if physicians feel demoralized, imagine how patients feel.”  

An ASCO educational resource highlights the unintended impact PAs on patients, citing increased anxiety, frustration and negative emotional and psychological well-being. As one patient noted, “That’s the last thing that I need as I fight for every minute of my life.”

Optimizing Access to Specialty Medications  

By integrating ePAs in existing EHR workflows, oncology providers overcome administrative burdens while improving patient experiences.  

• Eliminates time-consuming searches for PA requirements: ePA quickly determines if PA is required based on patients’ specific payer plan and policies. 

• Prechecks PA submissions for errors or omissions: Validates that necessary information is included in the authorization request, reducing preventable denials. 

• Increases transparency: Offers a comprehensive view of all PA statuses which in turn helps manage patient and provider expectations.  

• Lowers administrative cost: Improves overall efficiency and reduces time spent reworking preventable denials. 

• Addresses clinician and staff burnout: Frees time-challenged providers to focus on more rewarding, patient-centric work.  

With end-to-end ePA, oncologists offer patients a more seamless care experience, so they can focus on their health and well-being after a cancer diagnosis. 

Interested in how ePAs can improve cancer care?

Download our guide to learn more about simplifying access to oncology medications. earn more about simplifying access to oncology medications.